Peculiarities of diagnostic and treatment of the diverticular disease of the colon

Abstract

Introduction: Diverticular disease is one of the most prevalent medical conditions that affect Western populations. Symptomatic diverticula can lead to serious complications requiring both medical and surgical interventions to treat these complications when they occur. Imaging is used to establish the diagnosis and its extent and severity, and to detect the presence of any complications so that management can be directed appropriately. The most widely used examinations for the diagnosis of diverticulitis are barium enema, ultra-sound, and computed tomography. Goals of therapy should focus on alleviating symptoms in symptomatic disease and preventing recurrence and complications. The indications for emergency operative treatment include generalized peritonitis, uncontrolled sepsis, uncontained visceral perforation, the presence of a large abscess, and lack of improvement or deterioration within 3 days of medical management. Complications of chronic diverticulitis, including fistulas, strictures or stenosis, and most cases of colonic obstruction, are also treated surgically. The aim: To elaborate an algorithm of diagnostic and treatment in diverticular disease of the colon (DDC). To establish the efficiency of operative techniques in surgical treatment. Material and methods: 27 patients (14 males and 13 females), average age 65,2±10,9, diagnosed with diverticular disease of the colon were included in the research. Depending on presence of complications, therapeutic or operative treatment was used. Results: Age, obesity and lifestyle are the most important factors in pathogenesis of diverticular disease of the colon. It was noted an increased incidence of DDC and its complications in age decades 50-60 and 61-70. It was proposed to include in the mandatory set of methods for diagnostic of DDC barium enema (95% of sensibility), colonoscopy (84% of sensibility), as well as ultrasound and computed tomography as additional methods for identification of complications. In 10 patients (37%) was used therapeutic treatment and 17 patients (63%) required surgical intervention, the most frequent being sigmoid resection (34%). Complications after operation were registered in 4 patients (23%).